Ingestion of false hellebore plants can cross-react with a digoxin clinical chemistry assay

Introduction. We report a case of digoxin-like toxicity because of ingestion of foraged plants. This patient presented with nausea, vomiting, bradycardia, and hypotension after ingesting Veratrum viride (false hellebore). The patient's serum specimen demonstrated a positive digoxin level (0.38...

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Published inClinical toxicology (Philadelphia, Pa.) Vol. 48; no. 5; pp. 435 - 442
Main Authors Bechtel, L.K., Lawrence, D.T., Haverstick, D., Powers, J.S., Wyatt, S.A., Croley, T., Holstege, C.P.
Format Journal Article
LanguageEnglish
Published England Informa UK Ltd 01.06.2010
Taylor & Francis
Subjects
Biological Assay
Bradycardia - complications
Bradycardia - etiology
Chemistry, Clinical
Cross Reactions
Digoxin
Digoxin - blood
Digoxin - immunology
Eating
False hellebore
Humans
Hypotension - etiology
Immunoassay - methods
Immunoglobulin Fab Fragments
Nausea - complications
Plant Extracts
Plants - immunology
Veratrum
Veratrum Alkaloids
Veratrum viride
Vomiting - complications
Vomiting - etiology
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Summary:Introduction. We report a case of digoxin-like toxicity because of ingestion of foraged plants. This patient presented with nausea, vomiting, bradycardia, and hypotension after ingesting Veratrum viride (false hellebore). The patient's serum specimen demonstrated a positive digoxin level (0.38 ng mL) measured by a clinical tubidimetric immunoassay. We hypothesize that steroidal alkaloid compounds contained in V. viride cross-react with the Multigent™ Digoxin immunoassay reagent antibodies. Results. Plant extracts from V. viride demonstrated cross-reactivity to Multigent™ reagent antibodies but did not bind therapeutic DigiFab™ antibodies. Gas chromatography mass spectrometry analyses identified several steroidal alkaloid compounds present in the V. viride extracts: jervine, ribigirvine, solanidine, and veratraman. Conclusions. This study indicates that compounds extracted from V. viride can cross-react with a clinical Digoxin immunoassay. Yet these extracts did not bind DigiFab™ antibody fragments used for therapeutic intervention. Providers should not unnecessarily administer DigiFab™ fragments as an antidote in symptomatic V. viride toxic patients.
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ISSN:1556-3650
1556-9519
DOI:10.3109/15563651003733666